By Dr Ibrahima Socé Fall, Director of Neglected Tropical Diseases Department at WHO.
On my first World NTD Day since being appointed Director of WHO’s Global Program for Neglected Tropical Diseases, I feel at once the great honour of my position, at the head, so to speak, of a truly global movement and community, as well as great humility. For me personally, and for the worldwide network of dedicated partners, scientists, programme officers and fieldworkers, all working tirelessly to end the scourge of neglected tropical diseases (NTDs), this is a time for reflection – and then for action. The peak COVID-19 years took a terrible toll on many health programmes the world over; routine care suffered, dedicated disease-specific interventions suffered and many people, in some of the world’s poorest communities, saw their threadbare links with healthcare services damaged if not broken altogether.
It is in this context that we must reflect on our strategies as well as the practical steps we need to take now to ensure we are on the right path to hit our 2030 targets.
Some background will perhaps be useful here. WHO’s classification of neglected tropical diseases includes some twenty disparate diseases and disease groups. They are called tropical because they occur mainly in populations who inhabit the tropics of our planet while the neglected refers to the disease itself and its treatment historically, even if it might just as well be used to refer to the people whose lives these diseases have devastated. Some NTDs are caused by parasites, some by bacteria or fungi. They cause a range of debilitating symptoms, including disability, profound social stigma and even death. They do, however, have one element in common, inasmuch as they disproportionately affect the poorest, the most marginalised and the most vulnerable in our global society. These diseases lock their victims, along with their families, into cycles of poverty, taking away their ability to lead full and productive lives.
As we survey the scene, at the beginning of 2023, the first thing to do, I believe, is to salute the dedication and commitment of all those whose work – and calling – It is to reduce the burden of NTDs for more than one billion sufferers worldwide. Their hard work has already led to significant achievements, as every year more and more countries eliminate NTDs from their territories, and more and more people receive the treatments they need to be spared disability and death and to play a comprehensive and active role in their own lives and in the lives of their communities.
We find ourselves, however, at a critical juncture. The world has changed and is changing still, the ground moving, almost literally, beneath our feet. COVID-19 brought ravages to health systems the world over and brought particular hardship to systems that were already fragile. Climate change is having and will continue to have increasingly disastrous effects on public health across the world and will affect disease distribution and transmission in diverse and, in many cases, unforeseeable ways. When we take into account too the massive displacements of human populations in sub-Saharan Africa, Southeast Asia, Central and South America, as well as in Eastern and Central Europe, both as a result of armed conflict and political upheaval, and as a direct consequence of food and water insecurity, the picture becomes deeply worrying.
Population displacement combined with limited resources and fragile health infrastructure will exacerbate current disease burdens, while changes to the epidemiology and distribution of these diseases may also place currently unaffected populations at risk, thus undermining the efficacy of current disease control programmes. WHO now recognises climate change as ‘‘the single biggest health threat facing humanity”.
My predecessor as director of WHO/NTD, the late, inspirational Dr Mwelecele Ntuli Malecela, drove a global consultation which led to the publication of the road map for NTDs during the forthcoming decade. That flagship document, Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021−2030, was endorsed by the 73rd World Health Assembly in 2020 and laid out ambitious, achievable targets for all of the 20 neglected tropical diseases listed in the WHO portfolio.
It also outlined a number of key strategic pillars for the fight against NTDs.
The insistence on programmes that respect a ‘bottom up’ principle, rather than ‘top down’, on initiatives that promote country ownership of key health interventions, rather than imposition by external agencies, and on cross-cutting initiatives – otherwise known as collaboration between disciplines – laid the foundation for the work we now have before us.
The participation of young people, too, across all NTD activities, will also be key if we want to effect positive change and harness energy, values-based motivation and social connectedness, in order to spread information, generate innovative solutions and change communal behaviours and norms.
These are principles that underpin the pillars of the road map – and which need to apply across the spectrum of global public health interventions, within and beyond the NTD world.
The recent pandemic has amply demonstrated that without consideration of the bigger picture, such as the one I outlined above, and without working with and treating our populations holistically, we will not get ahead of existing neglected tropical disease curves, not to mention the curves of diseases and health emergencies yet to emerge. The increased interest shown by the global health community recently in One Health – the principle of extending healthcare to the joint treatment of human and animal populations as well as the environment – may have come about as a direct consequence of the likely zoonotic origin of the COVID-19 pandemic, but zoonoses have long been an area for cross-sectoral collaboration, along with foodborne infections, antimicrobial resistance and vector-borne disease, for example.
It is in this specific context, in the convergence of seemingly diverse health interests, that my particular interest lies. And in this respect, neglected tropical diseases constitute a veritable case study, as efforts to control, to eliminate and to eradicate NTDs are efforts that lead to tangible results both directly, for the many millions of people who suffer the burden of these diseases, and also indirectly, though no less effectively, as a key to unlock a great many other global health agendas.
Integration, collaboration is vital.
The ‘neglect’ element in neglected tropical diseases often comes about because the people and communities who suffer most as a result of them are figuratively – but also literally – at the very end of the healthcare road. These are communities who find themselves beyond the reach of mainstream or routine health interventions. NTD programmes, however, by their very nature, get to these populations, providing them with links to care systems. Interventions may be disease-specific but, crucially, they constitute a precious link to health services. NTD programmes provide door-to-door care in rural areas, providing also a basic level of community-based healthcare. In that sense, they are the first steps in the practical application of Universal Health Coverage, whereby minimum standards of care are available to all people, regardless of where and how they live. NTD programmes also train and employ a cadre of healthcare workers who provide critical front-line community care day in and day out. They are vital cogs in the delivery of many community interventions.
I believe that we must harness this valuable resource and give it the opportunity and the power to deliver even more. The prevention of many NTDs, for example, requires no more than a supply of clean water – but if we were to harness NTD interventions with wider work on water, sanitation and hygiene, the effects would be felt across the community, contributing to the sustainability of community life in the face of water and climate emergencies. NTDs offer us an opportunity to grapple with systemic, long-standing problems such as poverty and inequality; when we treat people suffering with NTDs we are, in effect, treating a whole host of other symptoms and problems.
Empowering the NTD network will also help us improve our understanding of the effects of climate change in remote and hard-to-access communities, deepening our understanding of the populations likely to be at risk and in need of future public health interventions.
As Director of the Department of Control of Neglected Tropical Diseases at WHO, this is my mission and I hope to inspire this vision in all those who work in the field.
I have already been profoundly impressed by the depth of commitment and the passion with which my colleagues apply themselves to improving the lives of people in the most vulnerable communities. My dearest hope is that I can take that inspiration and reflect it back, across the NTD community, as we strive together for sustainable, long-lasting, meaningful change, to the very last mile.